Prescription (Rx) and Over-the-Counter (OTC) Drug Misuse

1. Prescription (Rx) and Over-the-Counter (OTC) Drug Misuse Rachel Gonzales Ph.D.

2. What is Misuse? Any Rx and OTC drug can be “misused” Misuse = “Non-medical use” or any use that is outside of a medically prescribed regimen Examples can include: Taking for psychoactive “high” effects Taking in extreme doses Mixing pills Using with alcohol or other illicit substances Obtaining from non-medical sources

3. Public Health Problem • Adolescents: 12-17 • Young Adults: 18-24 • Older Adults

4. Rx Drug Misuse in the U.S. 6.4 million aged 12+ misused a Rx drug (non-medically in the past year) NSDUH, 2006

5. Adolescents & Young Adults

6. The Good News… Alcohol Cigarettes -35% Illicit Drugs -57% -47% MTF Study; Past Month Use for 12th Graders

7. Every Generation of Teens Looks for New Ways to Get“High”

8. Vicodin GHB The Bad News… Teens “getting high” using Rx or OTC drugs Generation “Pharming” Inhalants Cough medicine Inhalants

9. Epidemiology of Rx and OTC Drug Misuse Among Youth

10. New Landscape of Drug Abuse among Teens Marijuana 8.6 million 4.5 million Prescription Medicine 2.4 million Cough Medicine Crack/Cocaine 2.4 million Ecstasy 1.9 million Meth 1.9 million 1.3 million LSD Heroin 1.1 million Ketamine 1 million 1 million GHB NSDUH, 2006

11. "Generation Rx“ • Today's teens are more likely to have abused Rx and OTC drugs than most illicit drugs. • Every day 2,500 teens 12-17 try a painkiller for the 1sttime. NSDUH, 2006; MTF, 2006

12. Commonly Misused Rx Drugs • Opiates: pain-killers • Ex) Vicodin, Oxycontin • Sedatives/Tranquilizers (Depressants): treat anxiety and sleep disorders • Ex) Xanax, Valium • Stimulants: treat ADHD • Ex) Aderall, Ritalin, Concerta

13. DextromethorphanDXM (narcotic codeine) the active ingredient in over 100 cold/cough remedies. • Found in tablets, capsules, gel caps, lozenges & syrups • Teens discovered using mass quantities of DXM-containing products get them “high”. OTC Medicine Misuse

14. Coricidin HBP Cough & Cold Robitussin Cough products Sudafed Cough medicines Dimetapp DM Tylenol Cold products Vicks NyQuil and Dayquil Alka-Seltzer Plus Cold & Cough Triaminic Cough syrups Examples of Popular OTC Products

15. Top 5 Drugs Used by 12th Graders 3.8% Ritalin SOURCE: MTF, 2006

16. OTC Medications Misused by Teens SOURCE: MTF, 2006

17. Concerning Trends • Adolescents 12-13 • Teen Females • Young Adults 18-24

18. Extent of Rx & OTC Drug Misuse among Youth in California

19. Misuse of Rx Drugs in CA High Schools Misuse of painkillers (no prescription) to get high: • 15% of 11th graders • 9% of 9th graders • 4% of 7th graders California Student Survey 2006

20. The Pharming Subculture: Generation Rx Youth & Young Adult Risk Factors

21. Top Reasons for Rx & OTC Drug Misuse • Social with friends • Legal - WidelyAvailable • Easily Accessible • Affordable: Low Cost/Free • Safe - Prescribed • Non-addictive: Medicine Partnership Attitude Tracking Survey (PAT): Released in April 2006 by The Partnership for a Drug-Free America

22. Teens admit to misusing Rx drugs for reasons other than getting high, including to relieve pain or anxiety, to sleep better, just to experiment, to help with concentration orto increase alertness. (Boyd, McCabe, Cranford & young, 2006). • More than 1/3 of teens say they feel pressure to abuse Rx drugs and say using these drugs is an important part of fitting in with their friends. (Seventeen, 2006). • When teens abuse Rx drugs, they often characterize their use as “responsible” or “controlled” (Friedman, 2006). Recent Research: Why Teens Use?

23. Access & Availability • Family & Friends Home • Retail Pharmacies • The Internet

24. Social Networking Web SitesVenues for penetrating the Medicine Abuse Subculture MySpace YouTube LiveJournal Facebook • Footage of teens “high” • User Guides: Rx & OTC abuse instructions (recipes) • Blogs & videos of experiences

25. Social Rx & OTC Slang • Xbrs or xanabars:anti-anxiety Xanax • Vic: Vicodin • Skittles, Dex, Robo, Tussin, (any OTC cold pill containing DXM) • Triple Cs or CCC: Coricidin Cough & Cold med • SIZ’zurp: cough syrup & ETOH • Trail Mix: Pharm Party Keeping Parents Clueless

26. Increasing trend to use Psychiatric Drugs to Treat Youth Behavioral Problems… Another “access” source for youth to misuse Rx drugs.

28. Treatment for Rx Drug Misuse • Little known about specific treatments for addressing Rx drug abuse among youth. • Abusing Rx drugs before the age of 16 leads to a greater risk of dependence later in life. • The # of teens going into treatment for Rx drug abuse has increased by more than 300% during the last 10 years. • Between 2004-05, the proportion of youth seeking treatment for Rx drugs increased by 9%. TEDS, 2006

29. Rx Drug Misuse: Treatment Settings • Youth coming to treatment for “self-medicating” with Rx drugs to treat psychiatric condition. • Rx drug misuse among youth in treatment for co-occurring disorders is problematic: • “Cheeking”: saving unswallowed Rx meds for obtaining a later “high”

30. Older Adults

31. Older Adults Alcohol Prescribed drugs Over-the-counter meds Illicit Drugs

32. RX Drug Abuse in Older Adults • Older Adults account for 1/3 of all medications prescribed in the U.S. • 7.2 million (21.7%)receive at least 1 Rx annually. • Older adults use Rx drugs 3 times more than the general population. • On average, older persons take 4.5 medications per day. • 2.8 million older adults abuse Rx drugs in the last year. SAMHSA, 2006; NIDA, 2005

33. Older Adult Rx Drug Misuse Risk Factors

34. A Pill For Every ill More chronic illnesses Higher rates of co-morbid psychiatric conditions Depression, anxiety, cognitive, dementia Greater physical disabilities and psychological pain

35. Older AdultsRisks Factors • Prescribed multiple medications. • Long-term prescriptionscanlead to unintentional misuse -taking different doses. • Prescribed inappropriately high doses.

36. Risk of Rx Drug Misuse in Older Women • Live longer: greater likelihood for exposure to Rxs • Propensity for care seeking  greater exposure to Rxs • Biology/Metabolic differences • Metabolize alcohol & drugs differently than men, and have lower tolerance to Rx drugs and alcohol

37. Medical Exposure to Rx Drugs • Older women more likely to be exposed to Rx drugs for medical reasons than men. Simoni-Wastila et al, 2006

38. Consequences/Effects

39. The “High” • Slurred speech • Flushed skin, sweating • Loss of appetite • Mild distortions of color/sound • Confusion, forgetfulness • Clumsiness/loss of motor control • Mood swings, irritability • Excessive energy or sleepiness

40. Delusions Panic attacks Memory problems Blurred vision Stomach pain, nausea, vomiting High blood pressure & Rapid heart beat Numbness of fingers/toes Drowsiness & Dizziness Fever & headaches Rashes/itchy skin Loss of consciousness The “Lows”

41. Side Effects can be Lethal if… • Combining Rx & OTC medications. • Taking Rx and OTC meds with alcohol. • Using Rx and OTC with other illicit drugs. • Interactions: Rx & OTC meds with other physical medications (i.e., HIV or Hepatitis)

42. An estimated one in five older adults are negatively affected by combined difficulties with alcoholandRx medication abuse.

43. Rx & OTC Drug Over Doses • Last 2 months: Rapper Pimp C (Chad Butler): cough syrup & Hennessey– “sizerp” • This Year: Heath Ledger: lethal cocktail of Rx drugs - pain, sleeping, anti-anxiety • Last Year: Anna Nicole Smith & Son (Daniel) both died due to Rx drugs • Last 2 Years: Rapper ODB: fatal mixture of Rx drugs & cocaine

44. Teens Don’t Understand the Risks & Effects of Abusing Rx and OTC Medicines Over 50% believe that abusing these medicines to get high is NOT risky… Join Together, 2006

45. An Invisible Epidemic • Unrecognized • Under-screened • Under-treated

46. Parents Don’t Recognize Problem • Only 8% of parents are aware of Rx & OTC abuse. • 75% don’t talk to their kids about the problem. • Unaware that the drug supply can come from their own home.

47. Under-Screened 57.7% of physicians say they don't discuss Rx abuse with their patients because they believe they lie about it. 35.1% of physicians cite time constraints. 10.6% of physicians are concerned they won't be reimbursed for the time necessary to screen and treat a Rx-abusing patient. CASA Released Survey of Primary Care Physicians & Patients, 2000

48. Other Key Stakeholders • Lack of screening and awareness about Rx and OTC problem among: • Substance abuse treatment practitioners • Social workers, Juvenile delinquent counselors, probation officers • School teachers, nurses, & counselors McCabe, S.E., Teter, C.J., & Boyd, C.J. (2004)

49. Efforts to Address Rx & OTC Misuse

50. Youth Prevention Activities • ONDCP • 12 week national public awareness campaign • Began with 2 Ads aired during Super Bowl • 1st paid TV advertising targeting parents in 2 years. • DARE • New School Curriculum Addresses Rx and OTC Drug Abuse • Five Moms Campaign • Stopping Cough Medicine Abuse – keeping parents informed and educated of the issue